46‐kg abdominal tumor misdiagnosed as obesity: Unveiling healthcare bias due to obesity stigma

Obesity is a disease associated with an increased risk of cardiovascular diseases,diabetes, musculoskeletal disorders, and some cancers. Obesity stigma affect pa-tients and healthcare professionals leading to mistrust, poor adherence, noncom-pliance to screening, and misdiagnosis. We reported a case report of a patientsent to our referral center for surgical evaluation of long-standing severe obe-sity (BMI 59). Physical examination was significant for abdominal obesity witha hard consistency, but no cushingoid dysmorphism or lipodystrophy. No ab-dominal pain, pelvic pain, vaginal bleeding, or change in bowel movements werepresent. Tumor markers were normal except for an elevated Ca 19.9. Imagingshowed a large, intraperitoneal abdominal mass with no metastatic disease. Thepatient underwent surgery to remove a 46-kg complex ovarian cystic mass (cir-cumference: 160 cm, diameter: 67 cm), full of liquid and with six nodular areas.The mass was entirely extracted with an intact capsule. The cystic mass resultedin a well-differentiated intestinal-type adenocarcinoma with microinvasive foci,an endophytic borderline area (sec. WHO 2014), and mucinous-cystic areas withno atypia. The patient had postoperative bilateral basal pleural effusion resolvedwith conservative treatment and was discharged at home on postoperative day 12with an uneventful 90-day postoperative follow-up. In the present case report, a46 kg ovary mass was misdiagnosed as severe obesity, and the patient was referredfor bariatric evaluation. Unveiling biases related to obesity stigma is the first stepto ensuring better patient care. Obesity stigma awareness and a sustained effortfrom healthcare professionals are required to deliver adequate patient care to pa-tients with obesity.